Nurses should reflect carefully about the meaning and purpose of prayer in the clinical setting before engaging in prayer with patients. This article discusses the ethics of prayer with patients in regard to respectful care of the patient and integrity for the nurse. Five guidelines are offered to assist nurses in their ethical decisions about prayer with patients.
He said are you a religious man do you kneel down in forest groves and let yourself ask for help when you come to a waterfall mist blowing against your face and arms do you stop and ask for understanding at those moments
I said not yet but I intend to start today.
Raymond Carver 1
These lines from Raymond Carver's poem are a reminder to us all. People who face a health crisis may turn to prayer for comfort, even if this has not been a typical part of their daily lifestyle. Some patients may desire prayer as part of their health care. Nurses who choose to provide spiritual nurturing must think carefully about the appropriateness of prayer in professional service.
Faith-based health care institutions have long emphasized the importance of tending to the spiritual needs of patients. And praying with patients has traditionally been an expected part of care in such facilities. In recent years, the importance of spirituality in health care has also gained broad acceptance in the general culture. Researchers interested in the health-related effects of spirituality have generated a burgeoning literature, with numerous reports of empirical evidence for the positive benefits of practices like prayer and meditation. 2–4 Members of most faith traditions, whether patients or caregivers, probably did not need such evidence to convince them that prayer is a valuable part of their lives. But the rise of research in spirituality and health, with its accompanying professional conferences, seminars, journals, and academic course work, has created a synergy with faith-based health care in which the importance of prayer for patients is gaining renewed emphasis. 5,6
Prayer, as an intervention with patients, fits within the broader spectrum of spiritual care. From the inception of nursing as a practice discipline, nurses have been attuned to the spiritual needs of patients. 7 A review of current nursing theories shows that spirituality and spiritual care are considered concepts of central importance in the practice of nursing (eg, Neuman, Newman, Parse, Watson). 7–9 Scholars within the discipline of nursing are continuing to delineate the concept of spirituality and to describe methods by which nurses can provide appropriate spiritual care, including prayer, for their patients. 7,8,10 Building on nursing's rich heritage, we will focus on one aspect of spiritual care, that of prayer, in this article. Our purpose is to consider a set of normative principles that may guide nurses in their decisions about prayer with patients.
As an interest to include prayer in patient care seems to increase, the need for ethical reflection is pressing. 2,3,5,7,10–15 Attention to the vulnerability of patients and the variety of religious and spiritual backgrounds they may bring to the clinical setting should raise some important ethical questions. Because nursing has a well-established tradition of attending to patients' spiritual needs and resources, as an expected part of the nursing assessment, 7,10 querying a patient about his or her spiritual preferences is already deemed to be an appropriate professional responsibility. So the ethical questions are not about whether or not good nursing care should include consideration of patients' spiritual or religious values, including beliefs about prayer. Rather, the ethical questions focus on whether and how to include prayer in ways that are respectful of patients in the clinical setting. For example, if prayer is believed to be genuinely beneficial, should nurses go beyond offering to pray with patients and urge patients to engage in prayer? If patients are given the option of prayer with a nurse, will those who reject prayer be likely to wonder how this will affect the rest of their care? What about patients whose religious practices differ greatly from those of their nurse? Can the nurses, with integrity, participate in forms of prayer that are contrary to the nurse's own belief system? Finally, what should be done with patients' requests for prayer if the nurse does not believe in prayer at all?
These and a host of related questions give rise to the central inquiry of this article: What, if any, are the ethical responsibilities of nurses who are attuned to patients' spiritual resources and who care for the spiritual needs of those who may benefit from prayer? Answers to this question, we suggest, can be sought under 2 broad categories: the respectful care of the patient and the essential integrity of the nurse. Under these rubrics, we set forth a series of 5 guidelines we believe comport well with our culture's current understanding of ethics and with nursing's self-understanding of its professional responsibilities.
Our discussion will be facilitated by clarification of some of the central concepts. The first is prayer. According to Shelly and Fish, “Prayer is an intimate conversation between a person and God.” 11 This simple definition is probably effective in our culture for the vast majority of patients who believe in prayer. But there are also reasons to add nuance to this concept of prayer. Some, for example, may be uncomfortable with reference to God. They may prefer expressions such as Higher Power, the Absolute, the Sacred Source, the Holy, the Great Spirit, or some other way of designating the one to whom prayer is addressed. For others, conversation may not be part of prayer. Poloma, who has offered a 4-fold typology of prayer, identifies 1 type as meditative in which the one who prays takes “the stance of a listener” waiting for God to speak. 12 And within the prevalent faith traditions in our culture, common forms of prayer include invocation, praise, thanksgiving, petition, and benediction. For the purpose of this article, we define prayer as being in communion with God. But we keep in mind the many different ways of typifying prayer because these differences can become ethically important.
Two other concepts require clarification: religion and spirituality. It has become common to distinguish religious beliefs and practices from spirituality. Many people now say that they are spiritual but not religious, though it is uncommon to hear someone say that he or she is religious but not spiritual. The reasons for this are likely complex and an analysis of them is beyond our present scope. For our discussion, it is sufficient to note that the concept of religion is generally associated with the teachings and rituals of various faith traditions. In a richly multicultural and religiously diverse society, there seems to be more comfort in talking about spirituality than in discussing religiosity—the latter frequently being linked with arguments and strife. Spirituality, on the other hand, is often viewed as a universal human trait that arises from the human need for hope and meaning. 7 For definitional purposes, we accept the common distinctions between religiosity and spirituality. By religion we mean the convictions and characteristic practices of a community of faith. By spirituality we mean the human quest for ultimate meaning, purpose, and hope. It is worth noting that, for the vast majority of persons in our culture, a strong connection exists between spirituality and religion. The sacred texts, the shared religious symbols, and the rituals of a particular faith tradition generally shape spiritual practices, including prayer. True, people may be deeply spiritual with little or no tie to a religious tradition. Some spiritual people may even be hostile to organized religion. And some apparently religious people may not be particularly spiritual. Nevertheless, paying attention to the complex relationship between religion and spirituality can be ethically significant, as we hope to show.